Pikūnienė Ingrida, Saladžinskas Žilvinas, Basevičius Algidas, Strakšytė Vestina, Žilinskas Justas, Ambrazienė Rita
Department of Radiology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, LTU.
Department of Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, LTU.
Cureus. 2023 Sep 10;15(9):e45002. doi: 10.7759/cureus.45002. eCollection 2023 Sep.
Introduction Colorectal cancer is the third most diagnosed cancer globally. Lymph node metastases significantly affect prognosis, emphasizing the importance of early detection and management. Despite significant advances in conventional MRI's role in staging, improvements in advanced functional imaging such as diffusion-weighted imaging (DWI) in identifying lymph node metastases persist. Objectives The aim is to evaluate the effectiveness of apparent diffusion coefficient (ADC) MRI in evaluating lymph node staging in rectal cancer. Patients and methods In a prospective study, 89 patients with stage II-III rectal cancer were grouped into two treatments: pre-operative FOLFOX4 chemotherapy and standard pre-operative chemoradiotherapy. All underwent 1.5T MRI, with T2-weighted and DWI sequences. A radiologist defined regions of interest on the tumor, lymph nodes, and intact rectal wall to calculate ADC values. Results Rectal cancer ADC's receiver operating characteristic curve had an area under the curve (AUC) of 0.688 (P < 0.001), with optimal ADC cutoff at 0.99 x 10-3 mm2/s (sensitivity: 75%, specificity: 83%). For lymph nodes, AUC was 0.508 (P < 0.001), with a cutoff of 0.9 x 10-3 mm2/s (sensitivity: 78%, specificity: 67%). No correlation between tumor and lymph node ADC values was observed. In chemotherapy patients, "healthy" inguinal lymph nodes had higher ADC values than affected ones pre-treatment (P = 0.001), a disparity fading post-treatment (P = 0.313). For chemoradiotherapy patients, the ADC difference persisted pre and post-treatment (P = 0.001). Conclusion The study of ADC-MRI showed different ADC values between tumors and lymph nodes and highlighted ADC differences between treatment groups. Notably, no correlation was observed between tumor and lymph node ADC values. However, differences were apparent when comparing "healthy" inguinal nodes with lymph nodes affected by cancer.
引言
结直肠癌是全球第三大最常被诊断出的癌症。淋巴结转移显著影响预后，凸显了早期检测和管理的重要性。尽管传统MRI在分期中的作用取得了显著进展，但在识别淋巴结转移方面，诸如扩散加权成像（DWI）等先进功能成像的改进仍在持续。
目的
旨在评估表观扩散系数（ADC）MRI在评估直肠癌淋巴结分期中的有效性。
患者与方法
在一项前瞻性研究中，89例II - III期直肠癌患者被分为两种治疗组：术前FOLFOX4化疗和标准术前同步放化疗。所有患者均接受1.5T MRI检查，包括T2加权和DWI序列。一名放射科医生在肿瘤、淋巴结和完整直肠壁上定义感兴趣区域以计算ADC值。
结果
直肠癌ADC的受试者操作特征曲线下面积（AUC）为0.688（P < 0.001），最佳ADC截断值为0.99×10⁻³mm²/s（灵敏度：75%，特异性：83%）。对于淋巴结，AUC为0.508（P < 0.001），截断值为0.9×10⁻³mm²/s（灵敏度：78%，特异性：67%）。未观察到肿瘤和淋巴结ADC值之间的相关性。在化疗患者中，“健康”腹股沟淋巴结在治疗前的ADC值高于受影响的淋巴结（P = 0.001），这种差异在治疗后逐渐消失（P = 0.313）。对于同步放化疗患者，治疗前后ADC差异持续存在（P = 0.001）。
结论
ADC - MRI研究显示肿瘤和淋巴结之间存在不同的ADC值，并突出了治疗组之间的ADC差异。值得注意的是，未观察到肿瘤和淋巴结ADC值之间的相关性。然而，在比较“健康”腹股沟淋巴结与受癌症影响的淋巴结时差异明显。
